Distal revascularization–interval ligation for limb salvage and maintenance of dialysis access in ischemic steal syndrome Scott S. Berman, MD, RVT, Andrew.

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Presentation transcript:

Distal revascularization–interval ligation for limb salvage and maintenance of dialysis access in ischemic steal syndrome Scott S. Berman, MD, RVT, Andrew T. Gentile, MD, Marc H. Glickman, MD, Joseph L. Mills, MD, Richard L. Hurwitz, MD, Alex Westerband, MD, RVT, John M. Marek, MD, Glenn C. Hunter, MD, RVT, C.Scott McEnroe, MD, Martin A. Fogle, MD, Gordon K. Stokes, MD Journal of Vascular Surgery Volume 26, Issue 3, Pages 393-404 (September 1997) DOI: 10.1016/S0741-5214(97)70032-6 Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 1 DRIL procedure. Journal of Vascular Surgery 1997 26, 393-404DOI: (10.1016/S0741-5214(97)70032-6) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Digital plethysmography at rest (A) and during dialysis treatment (B) demonstrates severe digital ischemia during dialysis. Note drop in systemic blood pressure during dialysis treatment. Journal of Vascular Surgery 1997 26, 393-404DOI: (10.1016/S0741-5214(97)70032-6) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 2 Digital plethysmography at rest (A) and during dialysis treatment (B) demonstrates severe digital ischemia during dialysis. Note drop in systemic blood pressure during dialysis treatment. Journal of Vascular Surgery 1997 26, 393-404DOI: (10.1016/S0741-5214(97)70032-6) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 3 Arteriogram of patient with ischemic ulcerations demonstrates severe occlusive disease in antebrachial arteries. Journal of Vascular Surgery 1997 26, 393-404DOI: (10.1016/S0741-5214(97)70032-6) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 4 Actuarial DRIL patency and cumulative access patency rates at 18 months for 21 patients who underwent DRIL procedures. Journal of Vascular Surgery 1997 26, 393-404DOI: (10.1016/S0741-5214(97)70032-6) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 A, Intraoperative duplex scan shows flow reversal in artery distal to AV graft. Flow reversal is eliminated by access compression (arrow). B, Normalization of flow in distal artery after completion of DRIL procedure. Journal of Vascular Surgery 1997 26, 393-404DOI: (10.1016/S0741-5214(97)70032-6) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions

Fig. 5 A, Intraoperative duplex scan shows flow reversal in artery distal to AV graft. Flow reversal is eliminated by access compression (arrow). B, Normalization of flow in distal artery after completion of DRIL procedure. Journal of Vascular Surgery 1997 26, 393-404DOI: (10.1016/S0741-5214(97)70032-6) Copyright © 1997 Society for Vascular Surgery and International Society for Cardiovascular Surgery, North American Chapter Terms and Conditions